Robot or radiation? A qualitative study of the decision support needs of men with localised prostate cancer choosing between robotic prostatectomy and radiotherapy treatment

ObjectiveTo understand how best to support men diagnosed with localised prostate cancer to decide which treatment option best suits their needs, when robotic prostatectomy and radiotherapy are equally appropriate to offer them.MethodsTwenty-five men recently diagnosed with localised prostate cancer completed semi-structured interviews asking about information/decision-making needs before and/or after attending a combined clinic in which they consulted a urologist and a radiation oncologist regarding treatment options. Data was transcribed verbatim and thematically analysed.ResultsMost men preferred robotic prostatectomy pre-combined clinic and chose it afterwards. The thematic analysis revealed four themes: 1) trust in clinicians and the information they provide is critical for treatment choice, 2) perceived fit between treatment characteristics and personal circumstances, 3) additional considerations: specific side effects, socio-emotional and financial factors, and 4) need for tailored information delivery. Robotic prostatectomy was mistakenly believed to provide a more definitive cure than radiotherapy, which was seen as having a lesser lifestyle impact.ConclusionsTreatment choice is largely dependent on clinicians’ (mainly urologists’) recommendations.Practice implicationsPatients need more balanced information about alternatives to robotic prostatectomy earlier in the treatment decision-making process. Referral to a radiation oncologist or combined clinic shortly after diagnosis is recommended.     

What is the association between quality of treatment for depression and patient outcomes? A cohort study of adults consulting in primary care

Background

The association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The main objective of this study was to examine the association between receiving at least one minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6- and 12-months. Associations with receiving pharmacotherapy and/or psychotherapy and the role of severity of depression were examined.

Methods

This cohort study included 908 adults meeting criteria for previous-year MDE and consulting at one of 65 primary care clinics in Quebec, Canada. Multilevel analyses were performed.

Results

Results show that (i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; (ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and (iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months.

Limitations

Measures are self-reported. Participants were recruited at different stages over the course of their MDE.

Conclusions

This study shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions, but that those with more severe depressive symptoms are more likely to receive adequate treatment and improve across time.     

What is the relationship between dissociation and self‐harming behaviour in adolescents?

Deliberate self‐harm in adolescents is an increasing clinical problem, but there is a limited understanding of the mechanisms causing or maintaining this behaviour. One proposed mechanism is that of dissociation. However, the role this mechanism may play is unclear: although some suggest that adolescents engage in self‐harm to end the aversive experience of dissociation, others propose that self‐harm is used to purposefully trigger a dissociative state to avoid emotional pain. This systematic review is the first to evaluate the available evidence regarding the relationship between dissociation and deliberate self‐harm in adolescents (aged 18 or younger). Nineteen relevant studies were identified. These studies were limited by cross‐sectional design and poor methods of measurement, but some important conclusions could be drawn. The majority of studies found a positive correlation between the severity of dissociation and the severity and frequency of deliberate self‐harm in adolescents, and a small number of results suggest that dissociation mediates the relationship between childhood trauma and adolescent self‐harm.     

How do patients with rheumatic disease experience their relationship with their doctors? A qualitative study of experiences of stress and support in the doctor-patient relationship

This study is evaluated what patients with rheumatic disease perceive as important in their medical encounters. We interviewed two groups of patients: one with a well-defined inflammatory condition (rheumatoid arthritis (RA) or ankylosing spondylitis) (n = 12) and one with non-inflammatory widespread chronic pain such as fibromyalgia (n = 14). Both groups focused on their relationship to their doctor. Two central themes emerged as of importance: 'to be seen' and 'to be believed'. However, these themes had different connotations for the two groups. For the patients with inflammatory conditions, 'to be seen' implied being seen as an individual and not as a mere diagnosis, and 'to be believed' as far as pain and suffering were concerned. For patients with non-inflammatory chronic pain 'to be seen' and 'to be believed' primarily implied being able to obtain a useful somatic diagnosis. Practical implications of these findings are discussed.     

What is the evidence base for diagnosing hypertension and for subsequent blood pressure treatment targets in the prevention of cardiovascular disease?

The 1994 genocide against the Tutsi destroyed the health system in Rwanda. It is impressive that a small country like Rwanda has advanced its health system to the point of now offering near universal health insurance coverage. Through a series of strategic structural changes to its health system, catalyzed through international assistance, Rwanda has demonstrated a commitment towards improving patient and population health indicators. In particular, the rapid scale up of antiretroviral therapy (ART) has become a great success story for Rwanda. The country achieved universal coverage of ART at a CD4 cell count of 200 cells/mm3 in 2007 and increased the threshold for initiation of ART to ≤350 cells/mm3 in 2008. Further, 2013 guidelines raised the threshold for initiation to ≤500 cells/mm3 and suggest immediate therapy for key affected populations. In 2015, guidelines recommend offering immediate treatment to all patients. By reviewing the history of HIV and the scale-up of treatment delivery in Rwanda since the genocide, this paper highlights some of the key innovations of the Government of Rwanda and demonstrates the ways in which the national response to the HIV epidemic has catalyzed the implementation of interventions that have helped strengthen the overall health system.     

Solid–pseudopapillary neoplasms of the pancreas in men and women: do they differ?

Solid–pseudopapillary neoplasms (SPNs) of the pancreas are uncommon and occur preferentially in young women. The question whether the features of SPNs occurring in men differ from those in women has not yet been studied. For a better understanding of the clinicopathological features of SPNs of both sexes, we studied a series of 14 tumors surgically resected at a Japanese hospital within a period of 14 years. This series was composed of seven men and seven women. All these SPNs demonstrated nuclear and cytoplasmic accumulation of β-catenin protein in immunohistochemistry and 86% of them had activating mutations of β-catenin gene. No pancreatic neuroendocrine tumors showed such immunohistochemical findings and genetic alterations. In our series, most SPNs in women showed encapsulation by thick fibrous tissue and massive degenerative changes. Most SPNs in men exhibited solid components without prominent degenerative changes, even though they were of a similar size to those in women. These findings suggest that SPNs in men tend to be a solid mass with slower progression of degenerative changes during their growth compared to that in women. Nuclear accumulation of β-catenin appears to be a useful marker of SPN, which allows male SPNs to be correctly diagnosed despite their less typical features.     

What is relationship between the medial preoptic area,the organum vasculosum of the lamina terminalis and Kallmann syndrome?

The medial preoptic area is a structure located in the hypothalamic anteroventral third ventricle region, and is closely related to the olfactory brain development and sexual differentiation of the brain. The medial preoptic area surrounds the organum vasculosum of the lamina terminalis, and both structures are the main areas where synthesis of gonadotropin-releasing hormone occurs in the brain. Neurons synthesizing gonadotropin-releasing hormone migrate from the medial nasal epithelium to the rostral brain and reach the organum vasculosum of the lamina terminalis and the medial preoptic area. Kallmann syndrome is a genetic disorder which combines hypogonadotropic hypogonadism and anosmia. Hypogonadism is characterized by the absence or reduced levels of gonadotropin-releasing hormone and anosmia due to olfactory bulb aplasia. This paper speculates on the connection between the development of the medial preoptic area, the organum vasculosum of the lamina terminalis and olfactory bulbs with Kallmann syndrome, since the anteroventral third ventricle region is crucial for the normal development of these structures and its connection with the olfactory nerves and sexual maturation.     

What is the relationship between the “Fujisawa point” and postoperative knee valgus angle? A theoretical,computer-based study

BackgroundThe purpose of this study was to determine the relationship between the Fujisawa point and postoperative knee valgus angle and the anatomical factors influencing this relationship.MethodsAn experimental study was conducted including 116 patients with medial compartment knee osteoarthritis undergoing treatment with open-wedge high tibial osteotomy (OWHTO). Each patient received simulated HTO through the Fujisawa point in the picture archiving and communication system (PACS). The preoperative hip-knee-ankle (HKA) angle and lower extremity anatomical parameters were recorded before the computerized HTO simulation. The postoperative knee valgus angle was measured after this procedure. A second simulation HTO was performed to adjust the mechanical axis to the optimal valgus angle (4.5°) and calculate the percentage of the tibial plateau width where the Mikulicz line crossed the knee. The Spearman correlation test and multivariate regression were used for analysis.ResultsThe median preoperative HKA varus angle of this study cohort was 174.1° (170.8, 176.2°). The median knee valgus angle after simulated osteotomy through the Fujisawa point was 2.4° (2.1, 2.7°). The valgus angle was positively correlated with the tibial plateau width (r = 0.23, p = .013) and preoperative HKA angle (r = 0.32, p < .001). Multivariate regression analysis showed that the preoperative HKA angle was a significant contributor to the postoperative valgus angle. When conducting the osteotomy with the optimal valgus angle (4.5°), the percentage of the Mikulicz line passing through the tibial plateau was 71.93% (67–78%).ConclusionsThe preoperative HKA angle affects the postoperative valgus angle after HTO. If the optimal valgus angle of 4.5° is desired, a more lateral position of the Fujisawa point should be targeted during OWHTO, which accounts for approximately 71.9% of the tibial plateau.     

Colonoscopy aided by magnetic 3D imaging: is the technique sufficiently sensitive to detect differences between men and women?

Colonoscopy tends to be more difficult to perform in women. Women also experience more pain during flexible sigmoidoscopy, and the mean insertion distance of the instrument is less than in men. The 'Bladen system', first described in 1993, is a non-radiological method of continuously visualising the path of the endoscope using magnetic drive coils under the patient and a chain of sensors up the biopsy channel of the instrument. In 1998, results were published that used a novel computer graphics system (the 'RMR system'), in which a much more realistic endoscope could be produced using the stored positional data from the Bladen system. The RMR computer graphics system has been further refined to enable measurement of the anatomical lengths of different parts of the large intestine to an accuracy of greater than 5 mm. The system is used to analyse the results obtained in 232 patients undergoing a total colonoscopy. In women, the colonoscope tends to form loops in the sigmoid colon more readily than in men (p < 0.05). When the first 50 cm of the endoscope are inserted for the first time, the tip passes either up to or beyond the splenic flexure in 40/116, or 34.5%, of males, compared with 24/117, or 20.5%, of females (p = 0.0137). It is demonstrated that women have longer transverse colons than men, and the differences are especially apparent when a stiffening tube is used to splint the left side of the colon (p < 0.0001). The possible relevance of these observations to biomedical engineers and those manufacturing and assessing prototype endoscopes is discussed.     

What is the relation between number of sessions worked and productivity of radiologists—a pilot study?

Increasing workloads and the current austerity measures are putting UK radiology departments under considerable stress. We need to look at the most efficient ways to manage radiology departments in order to cope with increasing demand. Consequently, a system is needed that can compare productivity between radiologists with different jobs. We measured workload in a UK radiology department and compared the productivities of consultants working different numbers of sessions, which are called programmed activities (PAs), to identify the optimal job plan structure for reporting productivity. Reporting data was gathered from electronic records for 14 consultants working different numbers of PA during the period April 2010–March 2011. These were converted into relative value unit (RVU) scores using a modified RCSI RVU system. Crude and net workloads were calculated for each consultant by dividing their total RVU score by the number of PAs they were contracted for and how many they spent reporting. The consultants reported 118,001 imaging studies. There was statistically significant variation in productivity between consultants working different numbers of PAs on χ² analysis (p < 0.05). Consultants working 12 PAs were more productive than consultants working 11 PAs, with net workloads of 7636 RVU/PA/year versus net 6146 RVU/PA/year, p < 0.05. Although UK consultants working 12 PAs per week are more productive than their colleagues, the reasons why are unclear. We have identified a method that can be developed further to identify efficient working practices in UK radiology departments. However, a UK-specific RVU system would make this productivity analysis more accurate.     

Spinule formulation in the fish retina: is there an involvement of actin and tubulin? An electronmicroscopic immunogold study

Summary During light-adaption dendrites of teleost horizontal cells form finger-like processes, called spinules, which are characterized by synaptic membrane densities. To investigate the involvement of cytoskeletal elements in the formation and retraction of spinules, effects of the microtubule and actin inhibitors colchicine and cytochalasin D were examined by injection into the vitreous. Both substances inhibited the light-induced spinule formation. The ultrastructural immunolocalization of tubulin revealed labelling of dendrites only in their proximal parts. The distal parts of dendrites which invaginate into cone pedicles were free of label. Treatment with anti-actin revealed immunoreactivity along the entire length of dendrites up to the dendritic terminals. The spinules, however, showed no labelling. This finding does not support the hypothesis that spinules are protruded by actin polymerization. After cytochalasin D treatment the density of label in the dendritic terminals was enhanced by a factor of three, which suggests an accumulation of actin. Thus, spinule inhibition by cytochalasin D is probably caused by distortion of a functional actin network in the dendritic terminals.     

What is the influence of hormone therapy on homocysteine and crp levels in postmenopausal women?

OBJECTIVE:

To evaluate the influence of estrogen therapy and estrogen-progestin therapy on homocysteine and C-reactive protein levels in postmenopausal women.

METHODS:

In total, 99 postmenopausal women were included in this double-blind, randomized clinical trial and divided into three groups: Group A used estrogen therapy alone (2.0 mg of 17β-estradiol), Group B received estrogen-progestin therapy (2.0 mg of 17 β-estradiol +1.0 mg of norethisterone acetate) and Group C received a placebo (control). The length of treatment was six months. Serum measurements of homocysteine and C-reactive protein were carried out prior to the onset of treatment and following six months of therapy.

RESULTS:

After six months of treatment, there was a 20.7% reduction in homocysteine levels and a 100.5% increase in C-reactive protein levels in the group of women who used estrogen therapy. With respect to the estrogen-progestin group, there was a 12.2% decrease in homocysteine levels and a 93.5% increase in C-reactive protein levels.

CONCLUSION:

Our data suggested that hormone therapy (unopposed estrogen or estrogen associated with progestin) may have a positive influence on decreasing cardiovascular risk due to a significant reduction in homocysteine levels.     

What is the consistency between the results of needle biopsy and prostatectomy specimen pathology results? A pilot study

Background/aim The aim of this study was to establish the relationship between the needle biopsy and the pathology result after radical prostatectomy administrated for prostate cancer. Materials and methods We retrospectively analyzed 67 patients who had undergone radical prostatectomy from 2016 to 2019. All surgeries and all biopsies were performed in the third author’s urology department. Samples were collected through 12-core biopsy under local anesthesia. All specimens were studied in the pathology department of the third author’s center. The results evaluated were needle biopsies’ Gleason scores and prostatectomy specimens’ Gleason scores.Results Inclusion criteria were not having any neo-adjuvant treatment and being treated with surgery after needle biopsy. Gleason scores obtained from needle biopsies and prostatectomy specimens were evaluated. The comparison revealed that 39% of the tumors were undergraded, 7% were overgraded, and 54% had exact scoring in needle biopsies and prostatectomy specimens according to the detailed Gleason scoring as primary and secondary metrics. The patients were grouped into five categories according to the ISUP 2014 prostate cancer grading system. The relationship was strong with 64% of results staying in the same group after the operation; nevertheless, the correlation remained weak based on the kappa coefficient. Conclusion The information obtained from the needle biopsy is not a strong herald of the pathological result. Urologists should have awareness of this restraint when utilizing the needle biopsy’s Gleason score in decision making and treatment planning.     

Why do women with alcohol problems binge eat? Exploring connections between binge eating and heavy drinking in women receiving treatment for alcohol problems

Questionnaires assessing heavy drinking and binge eating were administered to 58 women with alcohol problems. A sub-sample of the binge-eaters then participated in qualitative interviews about their perceptions of the connections between their two problems. Seventy-one percent self-identified as binge-eaters with most reporting 'severe' binge eating. Binge-eaters were younger, more frequent drinkers and drank more often for emotional relief than non-binge-eaters. Binge eating and heavy drinking appeared to serve similar functions in a given client (i.e. emotional relief or reward functions). We discuss implications of the findings for the development of better treatments for women struggling with both health issues.